From the Guidelines
Treatment for mild atelectasis in both lungs should prioritize individualized PEEP to prevent progressive alveolar collapse and recruitment maneuvers to reverse alveolar collapse, as these interventions have been shown to be effective in improving lung function and preventing further complications. When managing mild atelectasis, it is crucial to address the underlying cause and promote lung re-expansion. According to the expert panel-based consensus recommendations published in the British Journal of Anaesthesia in 2019 1, individualized PEEP can prevent progressive alveolar collapse, and recruitment maneuvers can reverse alveolar collapse, but have limited benefit without sufficient PEEP. Some key considerations for treatment include:
- Decreasing compliance caused by surgical or anesthesia factors should be treated by appropriate interventions, such as adjusting ventilation settings or positioning the patient to improve lung expansion 1.
- Increasing F O2 may be effective in increasing oxygenation but is not an effective intervention to improve dynamic compliance of the respiratory system, and its role in the development of postoperative pulmonary complications (PPCs) requires further study 1.
- Other interventions such as deep breathing exercises, incentive spirometry, position changes, adequate hydration, and gentle coughing or huffing techniques can help increase lung volume, improve airflow to collapsed areas, and enhance mucus clearance.
- In some cases, chest physiotherapy with percussion and postural drainage may be recommended, especially if the atelectasis is due to mucus plugging or obstruction.
- Appropriate pain management is essential for patients with pain limiting deep breathing, as it can help improve lung function and prevent further complications.
- Medical evaluation is necessary if symptoms worsen or don't improve, as more aggressive interventions like bronchoscopy might be needed.
From the FDA Drug Label
Acetylcysteine solution, USP is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: ... Atelectasis due to mucous obstruction The treatment for mild atelectasis in both lungs may include N-acetylcysteine (PO) as an adjuvant therapy, specifically for cases where the atelectasis is due to mucous obstruction 2.
- The drug is indicated for use in conditions with abnormal, viscid, or inspissated mucous secretions.
- Atelectasis due to mucous obstruction is a specified condition for the use of N-acetylcysteine.
From the Research
Treatment Options for Mild Atelectasis in Both Lungs
- The treatment of atelectasis varies depending on the duration and severity of the causal disease, and may include chest physiotherapy, postural drainage, bronchodilator, and anti-inflammatory therapy 3.
- Chest physiotherapy, nebulised DNase, and possibly fibreoptic bronchoscopy might be helpful in patients with mucous plugging of the airways 4.
- In cases of passive and adhesive atelectasis, positive end-expiratory pressure might be a useful adjunct to treatment 4.
- Persistent mucous plugs should be removed by bronchoscopy 3.
Diagnostic Considerations
- Chest radiographs using both the anterior-posterior and lateral projections are mandatory to document the presence of atelectasis 3.
- Examination of air-bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved 4.
Mechanisms of Atelectasis
- Atelectasis may occur due to airway obstruction, compression of parenchyma by extrathoracic, intrathoracic, chest wall processes, and increased surface tension in alveoli and bronchioli 3.
- Lobar atelectasis can be caused by resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectasis from abdominal distension, and adhesive atelectasis due to increased surface tension 4.